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Prediction of early response to uterine arterial embolisation of adenomyosis: value of T2 signal intensity ratio of adenomyosis

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Abstract

Objectives

To identify imaging predictors for complete necrosis after uterine artery embolisation (UAE) via quantitative measurement of the signal intensity obtained from magnetic resonance imaging (MRI) of a patient with adenomyosis.

Methods

The MRIs of 119 patients with uterine adenomyosis, who underwent UAE, were retrospectively evaluated. Each lesion was classified based on its location and morphology on MRI. Thickness and signal intensity were measured in each adenomyosis and in the rectus muscle on the T2-weighted sagittal plane, and the T2-weighted signal intensity ratio (T2SR) was calculated. MR parameters were then compared in patients showing complete response that achieved complete necrosis and incomplete response after UAE via univariate and multivariate analysis. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of the predictor using MR parameters for differentiating the complete from the incomplete response.

Results

The complete necrosis rate was 66.4 % (79/119) after UAE for adenomyosis. Univariate and multivariate analysis results indicated that T2SR was associated significantly with complete necrosis (P = 0.012). Symptomatic adenomyosis with T2SR above 0.475 was associated with complete necrosis after UAE (sensitivity = 57.0, specificity = 70.0, area under the ROC curve [AUC] = 0.643).

Conclusion

T2SR of adenomyosis on pre-procedural MRI can be utilised as a predictor for early therapeutic response of UAE in adenomyosis.

Key Points

• Pre-procedural MRI helps clinicians predict early response of UAE in adenomyosis.

• T2SR may help predict UAE outcomes in adenomyosis.

• Pre-procedural MRI helps clinicians to select treatment options in adenomyosis.

• MR predictors can be used to counsel patients with symptomatic adenomyosis.

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Abbreviations

T2SR:

T2 signal intensity ratio

UAE:

uterine artery embolisation

AUC:

area under the ROC curve

References

  1. Benson RC, Sneeden VD (1958) Adenomyosis: a reappraisal of symptomatology. Am J Obstet Gynecol 76:1044–1057, discussion 1057-1061

    PubMed  CAS  Google Scholar 

  2. Ascher SM, Arnold LL, Patt RH et al (1994) Adenomyosis: prospective comparison of MR imaging and transvaginal sonography. Radiology 190:803–806

    PubMed  CAS  Google Scholar 

  3. Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T (2005) MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics 25:21–40

    Article  PubMed  Google Scholar 

  4. Farquhar C, Brosens I (2006) Medical and surgical management of adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:603–616

    Article  PubMed  Google Scholar 

  5. Meyers ER, Steege JF (1998) Risk adjustment for complications of hysterectomy: utility of routinely collected administrative data. Prim Care Update Ob Gyns 5:202–203

    Article  PubMed  Google Scholar 

  6. Volkers NA, Hehenkamp WJ, Smit P, Ankum WM, Reekers JA, Birnie E (2008) Economic evaluation of uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: results from the randomized EMMY trial. Journal of vascular and interventional radiology. J Vasc Interv Radiol 19:1007–1016, quiz 1017

    Article  PubMed  Google Scholar 

  7. Siskin GP, Tublin ME, Stainken BF, Dowling K, Dolen EG (2001) Uterine artery embolization for the treatment of adenomyosis: clinical response and evaluation with MR imaging. AJR Am J Roentgenol 177:297–302

    PubMed  CAS  Google Scholar 

  8. Kim MD, Kim S, Kim NK et al (2007) Long-term results of uterine artery embolization for symptomatic adenomyosis. AJR Am J Roentgenol 188:176–181

    Article  PubMed  Google Scholar 

  9. Popovic M, Puchner S, Berzaczy D, Lammer J, Bucek RA (2011) Uterine artery embolization for the treatment of adenomyosis: a review. J Vasc Interv Radiol 22:901–909

    Article  PubMed  Google Scholar 

  10. Goodwin SC, McLucas B, Lee M et al (1999) Uterine artery embolization for the treatment of uterine leiomyomata midterm results. J Vasc Interv Radiol 10:1159–1165

    Article  PubMed  CAS  Google Scholar 

  11. Bratby MJ, Walker WJ (2009) Uterine artery embolisation for symptomatic adenomyosis – mid-term results. Eur J Radiol 70:128–132

    Article  PubMed  CAS  Google Scholar 

  12. Pelage JP, Jacob D, Fazel A et al (2005) Midterm results of uterine artery embolization for symptomatic adenomyosis: initial experience. Radiology 234:948–953

    Article  PubMed  Google Scholar 

  13. Kim MD, Kim YM, Kim HC et al (2011) Uterine artery embolization for symptomatic adenomyosis: a new technical development of the 1-2-3 protocol and predictive factors of MR imaging affecting outcomes. J Vasc Interv Radiol 22:497–502

    Article  PubMed  Google Scholar 

  14. Byun JY, Kim SE, Choi BG, Ko GY, Jung SE, Choi KH (1999) Diffuse and focal adenomyosis: MR imaging findings. Radiographics 19 Spec No:S161–170

    PubMed  CAS  Google Scholar 

  15. Reinhold C, Tafazoli F, Mehio A et al (1999) Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. Radiographics 19 Spec No:S147–S160

    PubMed  CAS  Google Scholar 

  16. Kroencke TJ, Scheurig C, Poellinger A, Gronewold M, Hamm B (2010) Uterine artery embolisation for leiomyomas: percentage of infarction predicts clinical outcome. Radiology 255:834–841

    Article  PubMed  Google Scholar 

  17. Popovic M, Berzaczy D, Puchner S, Zadina A, Lammer J, Bucek RA (2009) Long-term quality of life assessment among patients undergoing uterine fibroid embolization. AJR Am J Roentgenol 193:267–271

    Article  PubMed  Google Scholar 

  18. Hehenkamp WJ, Volkers NA, Birnie E, Reekers JA, Ankum WM (2008) Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy—results from the randomized clinical Embolisation versus Hysterectomy (EMMY) Trial. Radiology 246:823–832

    Article  PubMed  Google Scholar 

  19. Bradley LD (2009) Uterine fibroid embolization: a viable alternative to hysterectomy. Am J Obstet Gynecol 201:127–135

    Article  PubMed  Google Scholar 

  20. Jha RC, Takahama J, Imaoka I et al (2003) Adenomyosis: MRI of the uterus treated with uterine artery embolization. AJR Am J Roentgenol 181:851–856

    PubMed  Google Scholar 

  21. Kitamura Y, Allison SJ, Jha RC, Spies JB, Flick PA, Ascher SM (2006) MRI of adenomyosis: changes with uterine artery embolization. AJR Am Roentgenol 186:855–864

    Article  Google Scholar 

  22. Cura M, Cura A, Bugnone A (2006) Role of magnetic resonance imaging in patient selection for uterine artery embolization. Acta Radiol 47:1105–1114

    Article  PubMed  CAS  Google Scholar 

  23. Beilby JO, Farrer-Brown G, Tarbit MH (1971) The microvasculature of common uterine abnormalities, other than fibroids. J Obstet Gynaecol Br Commonw 78:361–368

    Article  PubMed  CAS  Google Scholar 

  24. Schindl M, Birner P, Obermair A, Kiesel L, Wenzl R (2001) Increased microvessel density in adenomyosis uteri. Fertil Steril 75:131–135

    Article  PubMed  CAS  Google Scholar 

  25. Lee JK, Gersell DJ, Balfe DM, Worthington JL, Picus D, Gapp G (1985) The uterus: in vitro MR-anatomic correlation of normal and abnormal specimens. Radiology 157:175–179

    PubMed  CAS  Google Scholar 

  26. Scoutt LM, Flynn SD, Luthringer DJ, McCauley TR, McCarthy SM (1991) Junctional zone of the uterus: correlation of MR imaging and histologic examination of hysterectomy specimens. Radiology 179:403–407

    PubMed  CAS  Google Scholar 

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Acknowledgements

The authors have been supported by the National Cancer Center, South Korea (grant nos. 0910140-1 and 0910140-2). Forty of the 119 patients enrolled in the present study were the same patients described in a previously published paper [13].

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Dae Chul Jung, Man Deuk Kim, Young Taik Oh, Jong Yun Won & Do Yun Lee

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  1. Dae Chul Jung
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  2. Man Deuk Kim
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  3. Young Taik Oh
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Correspondence to Man Deuk Kim.

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Jung, D.C., Kim, M.D., Oh, Y.T. et al. Prediction of early response to uterine arterial embolisation of adenomyosis: value of T2 signal intensity ratio of adenomyosis. Eur Radiol 22, 2044–2049 (2012). https://doi.org/10.1007/s00330-012-2436-z

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  • DOI: https://doi.org/10.1007/s00330-012-2436-z

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